The Menopause Herb Garden

Supplements to consider when menopause is causing you trouble.

By The North American Menopause Society

Cimicifuga racemosa

Photograph: iStock

Many women are “going green” in their search for alternative therapies for menopause-related symptoms. The North American Menopause Society (NAMS) is happy to offer a scientific guide to the garden, although we do recommend that you consult your healthcare provider to determine which products might be appropriate for you. Not all herbs are risk-free. The following herbal products are often used by women to ease various menopause-related symptoms. Most use is in the form of dietary supplements, not the plants themselves.

Black cohosh (Actaea racemosa, Cimicifuga racemosa)

This herb is the most widely studied for treatment of the most common menopause-related symptom, hot flashes. Although studies of its effectiveness in reducing hot flashes have proved inconclusive, some women report that it has helped them. A 2006 study found that a combination of black cohosh and St. John’s wort was better than placebo in treating menopausal symptoms. The exact mechanism of action is unknown, although black cohosh appears to have little or no estrogen effects, which reduces concerns about its harm to hormone-sensitive tissue (such as the uterus and breast). Some experts believe longer studies are needed to ensure safety. Women should also be aware that black cohosh use has been associated with liver problems, although these occurrences were rare.

Red clover (Trifolium pratense)

In five quality studies, no consistent or conclusive evidence was found that red clover extract reduced hot flashes. As with black cohosh, however, some women claim that red clover has helped them. Studies report few side effects and no serious health problems with use. But studies in animals have raised concerns that red clover might have harmful effects on hormone-sensitive tissue.

Dong quai (Angelica sinensis)

Dong quai has been used in Traditional Chinese Medicine to treat gynecologic conditions for more than 1,200 years. The one quality clinical study of dong quai conducted to check if it could reduce hot flashes did not find it to be effective. (Some experts on Chinese medicine point out that the preparation studied was not the same as used in traditional Chinese practice.) Dong quai can trigger heavy menstrual bleeding and should never be used by women with fibroids or blood-clotting problems, such as Von Willebrand’s disease, or by women taking drugs that affect clotting, such as warfarin (Coumadin).

Ginseng (Panax ginseng or Panax quinquefolius)

Research has shown that ginseng may help with some menopause-related complaints (such as mood swings) and with improving one’s overall sense of well-being. However, it has not been found to be helpful for hot flashes. Women should exercise caution if taking anticoagulant therapy. Some experts contraindicate the use of ginseng with antihypertensives or stimulants, including dietary supplement remedies containing ma huang, ephedrine or guarana.

St. John’s wort (Hypericum perforatum)

St. John’s wort is used by some to treat mild to moderate depression, anxiety and/or sleep disorders. A 2006 review of studies using St. John’s wort for mood/anxiety disorders in perimenopausal and postmenopausal women showed significant improvement in five out of seven research trials. It should be taken with food to minimize stomach upset. It is also associated with fatigue and may increase sun sensitivity (so be sure to wear sunscreen and avoid sunbathing while taking St. John’s wort). This herb interacts with several drugs; for example, it reduces the effectiveness of birth control pills.

Valerian (Valeriana officinalis)

This herb acts as a sedative and is used primarily to treat insomnia and nervousness. Studies have shown that valerian improves sleep quality without substantial side effects. Additionally, it does not appear to interact with alcohol to intensify drowsiness. The usual daily dose of valerian extract is 100 to 600 mg and of the crude root, 2,000 to 4,000 mg.